Treatment

We generally start treating sinus and allergy issues beginning with the least invasive or disruptive option, and progressing to most invasive (or surgery) if necessary. Because these are not typically life-threatening issues, we really don’t “have to” do anything. We prefer to educate patients and allow them to decide how far to go with therapy. We certainly do not want to make the treatment worse than the disease.

Plan A includes the medical therapy options described in the links below. This always includes nasal saline irrigations and usually includes a topical nasal steroid spray.

Immunotherapy is the only allergy treatment that has the potential to cure the disease. It gets at the cause of the problem, rather than to just treat the symptoms. Most physicians agree that immunotherapy is underutilized and we are really seeing that with the new asthma guidelines as well as in treatment recommendations for eosinophilic esophagitis.

Interestingly, Immunotherapy involves the administration of the substances that trigger allergies to the patient on a regular basis. Although it seems counterintuitive, it seems to correct the immune system’s hyper-responsiveness. Currently immunotherapy can be administered as subcutaneous shots or as an under the tongue tablet or drops.

Allergy Shots

Allergy Drops

Method of Administration

Shot in the Arm(s)

A Drop Under the Tongue

Insurance Coverage

Yes

NO

Risk of Anaphylaxis

Small

None Reported

Adverse Reactions

Multiple (Swelling, Itching, Hay fever, etc.)

Nausea, Itching/Swelling/Tingling in the Mouth

Physician Visit Required?

Weekly for Years

Every 6-12 Months

Allergy Testing Required

Yes (every 1-3 years depending on the allergy profile)

Yes (every 1-3 years depending on the allergy profile)

Insurance Coverage for Allergy Testing

Yes for Most Insurances

Yes for Most Insurances

Contraindications?

Yes (beta-blockers, history of anaphylaxis, young children, infants; severe asthmatics)